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首页> 外文期刊>Implementation Science >Nudge strategies to improve healthcare providers’ implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews
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Nudge strategies to improve healthcare providers’ implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews

机译：提高医疗保健提供者的循证指南，政策和实践的实施：对Cochrane系统审查中的试验进行系统审查

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BACKGROUND:Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an individual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews.METHODS:As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, individual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework.SYNTHESIS:The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects.RESULTS:Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds?Ratio was 1.62 (1.13, 2.76).CONCLUSIONS:This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change.TRIAL REGISTRATION:This review was not prospectively registered.
机译：背景：轻推干预措施是那些寻求修改社会和物理环境的人，以提高与个人的内在价值观对齐的潜意识行为的能力，而不会积极限制选择。本研究旨在描述有关Cochrane系统评论中临床医生的临床医生，政策和实践的临床策略的应用和影响。方法：由于使用不同的术语，用于描述轻推，这项研究检查了内心的研究相关系统评价。在2016年和2018年间在Cochrane图书馆发布的所有系统评论，筛选出来的两阶段筛查过程，以审查包括定量研究，以改善医疗保健提供者之间的准则。其次，如果是（i）随机对照试验（RCT），（ii）在至少一个干预栏中列出了一种有关的干预措施，（ii），将包括一项有关系统评论中的个人研究，并明确旨在提高临床医生实施行为的临床策略。我们根据Mindspace框架分类为引发，显着性和影响，违约，奖励，承诺和自我和自我，常规和信使，计算：使用每个轻推策略的试验的数量和百分比。由于具有实质性的异质性，我们没有进行META分析。相反，我们计算了在研究点估计和95％的置信区间内，并使用了投票计数方法来探索效果。结果：七项审查包括42项试验报告57个结果。最常见的轻推策略是初步（69％），然后是规范和信使（40％）。在57个结果中，86％对假设方向的临床人员行为产生了影响，其中53％的统计学意义。对于连续结果，中值效应尺寸为0.39（0.22,0.45），同时为二分法结果，中位数率α比为1.62（1.13,2.76）。结论：本综述包括Cochrane系统审查中包含的42个RCT，发现了影响临床行为的轻推策略至少与针对基于循证指南的实施的其他干预措施相当。虽然不确定性仍然存在，但审查提供了持续调查对支持提供商行为变革的提升性干预措施的评估和应用的理由.Trial注册：本综述未经前瞻性注册。

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